HFMA CRCR 2026 FINAL EXAM MEGA-BANK | 200 UNIQUE QUESTIONS + RATIONALES | VERSIONS A & B | FULL CURRICULUM COVERAGE

HFMA CRCR 2026 FINAL EXAM MEGA-BANK | 200 UNIQUE QUESTIONS + RATIONALES | VERSIONS A & B | FULL CURRICULUM COVERAGE 1. Through what document does a hospital establish compliance standards? A. Corporate bylaws B. Medical staff rules C. Code of Conduct D. Policies and procedures manual Correct Answer: C. Code of Conduct Rationale: The Code of Conduct formally establishes organizational expectations for ethical behavior and compliance with laws and regulations. While policies and bylaws support operations, the Code of Conduct is the primary compliance standard document referenced by HFMA and OIG. ________________________________________ 2. What is the purpose of the OIG Work Plan? A. To outline hospital billing policies B. To identify acceptable compliance programs in various provider settings C. To establish Medicare payment rates D. To regulate private insurance plans Correct Answer: B. To identify acceptable compliance programs in various provider settings Rationale: The OIG Work Plan identifies areas of risk, enforcement priorities, and compliance expectations across healthcare provider types. It guides organizations in building and maintaining effective compliance programs. ________________________________________ 3. If a Medicare patient is admitted on Friday, which services fall within the three-day DRG window rule? A. Diagnostic services provided Monday–Friday B. All outpatient services provided during the week C. Non-diagnostic services provided Tuesday through Friday D. Only services provided on the admission date Correct Answer: C. Non-diagnostic services provided Tuesday through Friday Rationale: Under the DRG window rule, non-diagnostic outpatient services provided within three days prior to admission (or one day for non-IPPS hospitals) are bundled into the inpatient claim. ________________________________________ 4. What does a modifier allow a provider to do? A. Change the CPT code definition B. Increase reimbursement automatically C. Report a specific circumstance without changing the code definition D. Replace a diagnosis code Correct Answer: C. Report a specific circumstance without changing the code definition Rationale: Modifiers clarify special circumstances (e.g., bilateral procedures) but do not alter the core definition of the CPT/HCPCS code. ________________________________________ 5. If outpatient diagnostic services are provided within three days of admission to an IPPS hospital, what must happen to these charges? A. They are bundled into the inpatient claim B. They are denied by Medicare C. They must be billed separately to the Part B carrier D. They are written off Correct Answer: C. They must be billed separately to the Part B carrier Rationale: Diagnostic services are excluded from DRG bundling and are billed separately under Medicare Part B, even if provided within the three-day window. ________________________________________ 6. What is a recurring or series registration? A. A registration created daily B. A new registration for each encounter C. One registration record for multiple days of service D. A temporary registration Correct Answer: C. One registration record for multiple days of service Rationale: Recurring registrations are used for services such as therapy or dialysis where multiple visits occur over a defined period. ________________________________________ 7. What are non-emergency patients who arrive without prior notification called? A. Scheduled patients B. Direct admissions C. Unscheduled patients D. Observation patients Correct Answer: C. Unscheduled patients Rationale: Unscheduled patients present without appointments or advance notice but do not meet emergency criteria. ________________________________________ 8. Which statement applies to the observation patient type? A. Observation replaces inpatient admission B. Observation is billed as inpatient care C. Observation is used to evaluate need for inpatient admission D. Observation lasts longer than inpatient stays Correct Answer: C. Observation is used to evaluate need for inpatient admission Rationale: Observation status allows providers to monitor and assess a patient before deciding on inpatient admission. ________________________________________ 9. Which services are hospice programs required to provide around the clock? A. Social work and counseling B. Nursing, pharmacy, and physician services